Incidence and Risk Factors for Hypoglycemia During Fetal-to-Neonatal Transition in Premature Infants

Asymptomatic hypoglycemia among preterm newborns: A cross-sectional analysis

BACKGROUND

Hypoglycemia is the commonest metabolic abnormality encountered in newborns. Besides, there is a growing body of evidence that links the causes of early neonatal mortality to neonatal hypoglycemia in Tanzania. However exact factors associated with asymptomatic hypoglycemia in preterm newborns are not known.

OBJECTIVE

To assess factors associated with asymptomatic hypoglycemia among preterm newborns.

MATERIALS AND METHODS

A cross sectional, analytical hospital- based study was carried out at Dar es salaam public regional referral hospitals. Preterm newborns with asymptomatic hypoglycemia were the target population. Data on demographic and clinical characteristics of preterm newborns and their mothers were collected and analyzed using Epi-Info™ software version 7.4. Main data analysis was done by applying a multivariable binary logistic regression model with neonatal random glycaemia coded in a binary fashion at a cut-off point of 2.6 mmol/L. An α-level of 5% was used as a limit of type I error.

RESULTS

We recruited and analysed 217 preterm newborns within 6-24 hours post-delivery. Male: Female = 1.1:1 (females n = 105, 48.4%). Median glycemic level was 2.6 (IQR; 2.1-3.9) mmol/L. Median gestational age at delivery was 33 (IQR: 30-35) weeks. Breastfeeding within 1st hour post-delivery was a statistically significant factor against glycemic levels associated with hypoglycemia (OR; 0.123, 95%-CI; 0.052-0.287) in a fitted multivariable logistic regression model.

CONCLUSION

About half of all preterm newborns studied had glycemic values in a statistical range associated with hypoglycemia. Exclusive breast feeding within 1st hour post-delivery was associated with glycemic levels protective from risk of asymptomatic neonatal hypoglycemia.

RECOMMENDATIONS

Exclusive breastfeeding practices within 1st hour post-delivery may need to be emphasized to all expectant mothers in order to avoid potential risk of asymptomatic hypoglycemia in preterm newborns.

Variability in Diagnosis and Management of Hypoglycemia in Neonatal Intensive Care Unit

OBJECTIVE

 Hypoglycemia, the most common metabolic derangement in the newborn period remains a contentious issue, not only due to various numerical definitions, but also due to limited therapeutical options which either lack evidence to support their efficacy or are increasingly recognized to lead to adverse reactions in this population. This study aimed to investigate neonatologists' current attitudes in diagnosing and managing transient and persistent hypoglycemia in newborns admitted to the Neonatal Intensive Care Unit (NICU).

METHODS

 A web-based electronic survey which included 34 questions and a clinical vignette was sent to U.S. neonatologists.

RESULTS

 There were 246 survey responses with most respondents using local protocols to manage this condition. The median glucose value used as the numerical definition of hypoglycemia in first 48 hours of life (HOL) for symptomatic and asymptomatic term infants and preterm infants was 45 mg/dL (2.5 mmol/L; 25-60 mg/dL; 1.4-3.3 mmol/L), while after 48 HOL the median value was 50 mg/dL (2.8 mmol/L; 30-70 mg/dL; 1.7-3.9 mmol/L). There were various approaches used to manage transient and persistent hypoglycemia that included dextrose gel, increasing caloric content of the feeds using milk fortifiers, using continuous feedings, formula or complex carbohydrates, and use of various medications such as diazoxide, glucocorticoids, and glucagon.

CONCLUSION

 There is still large variability in current practices related to hypoglycemia. Further research is needed not only to provide evidence to support the values used as a numerical definition for hypoglycemia, but also on the efficacy of current strategies used to manage this condition.

KEY POINTS

· Numerical definition of glucose remains variable.. · Strategies managing transient and persistent hypoglycemia are diverse.. · There is a need for further research to investigate efficacy of various treatment options..

Factors associated with neonatal hyperinsulinemic hypoglycemia, a case-control study

OBJECTIVES

We aimed to identify perinatal risk factors associated with hyperinsulinemic hypoglycemia in neonates. Secondary objectives included an examination of clinical and biochemical characteristics at the time of diagnosis and an exploration of the duration of diazoxide therapy.

METHODS

A case-control study was conducted, involving individual chart reviews of inborn infants diagnosed with hyperinsulinemic hypoglycemia (the HH group) between 2014 and 2021. These cases were paired with controls (the non-HH group) belonging to the same gestational age (GA) strata who did not exhibit HH or only had transient postnatal hypoglycemia.

RESULTS

A total of 52 infants with HH were matched with corresponding controls. The mean GA in the HH group was 34.4 ± 3.1 weeks. Notably, the HH group exhibited lower mean minimum plasma glucose (PG) levels and required higher glucose infusion rates in comparison to the non-HH group (26.5 ± 15.6 vs. 49.1 ± 37.7 mg/dL and 12.9 ± 3.8 vs. 5.7 ± 2.1 mg/kg/min, respectively; p<0.001 for both). After adjusting for potential confounding factors, only two variables, fetal growth restriction (FGR) and neonatal sepsis, demonstrated significant associations with HH (adjusted odds ratio [95 % confidence interval]: 8.1 [2.1-31.0], p=0.002 and 6.3 [1.9-21.4], p=0.003, respectively). The median duration of diazoxide therapy for the HH group was 4 months.

CONCLUSIONS

FGR and neonatal sepsis emerged as notable risk factors for HH. These infants exhibited lower PG levels and necessitated higher glucose infusion rates compared to their non-HH counterparts. Importantly, a substantial proportion of the HH group received diazoxide therapy, with a median treatment duration of 4 months.

Fifteen-minute consultation: Investigation and management of hypoglycaemia in the term-born infant

Hypoglycaemia in term infants is very common. Deciding on appropriate investigations and management is often challenging. The aims of this article are to help with understanding when, how and why to investigate symptoms of hypoglycaemia in full-term infants (born ≥37 weeks' gestational age).

Determinants of Hypoglycemia in Premature Vietnamese Infants: A Case-Control Study

Background Premature infants are more likely to experience hypoglycemia. Early recognition and prompt therapy are essential to avoiding neurological sequelae in the future. This study aimed to identify the determinants of hypoglycemia in premature Vietnamese infants. Methodology This was a case-control study conducted at the Neonatal Intensive Care Unit, The Women and Children Hospital of An Giang, Vietnam. Hypoglycemia was defined as a plasma glucose value of less than 2.6 mmol/L (47 mg/dL) after two hours postpartum. Maternal and neonatal information was collected and analyzed. Both bivariate and multiple logistic regression models were used to identify the risk factors of neonatal hypoglycemia (NH) Results A total of 65 cases and 195 controls were included in the study. Gestational diabetes mellitus (GDM) (adjusted odds ratio [AOR] 3.78, 95% confidence interval [CI] 1.69-8.52; P < 0.001) and excessive gestational weight gain (GWG) (AOR 2.80, 95% CI 1.12-6.98; P < 0.026) were associated with NH in the multiple logistic regression model. An observed positive interaction between gestational hypertension and GDM on NH yielded an odds ratio (OR) of 6.29 (95% CI 2.46-16.64). Conclusions GDM, excessive GWG, and the interaction between gestational hypertension and GDM were the determinants of hypoglycemia in premature infants.

Analysis of risk factors of neonatal hypoglycemia and its correlation with blood glucose control of gestational diabetes mellitus: A retrospective study

This study aimed to investigate the risk factors associated with neonatal hypoglycemia and its correlation with blood glucose control in patients with gestational diabetes mellitus (GDM). This study was a retrospective study. 880 pregnant women with GDM and their newborns were hospitalized from January 2018 to December 2022 in our hospital. The clinical information of GDM pregnant women and their newborns were reviewed and the hemoglobin A1c (HbA1c) values measured within 1 week before delivery were collected. According to the occurrence of neonatal hypoglycemia, which was divided into the control and observation groups. Logistic regression model was used to estimate the potential factors associated with neonatal hypoglycemia. The association between HbA1c of pregnant women before delivery and abnormal glucose metabolism in newborns was examined using spearman correlation analysis. A total of 104 cases of hypoglycemia occurred in neonates delivered by 880 GDM women and the incidence of neonatal hypoglycemia was 11.82%. There were significant differences in pre-pregnancy overweight or obesity, delivery mode, maternal blood sugar control effect and neonatal feeding standard between the 2 groups of GDM women (P < .05). Pre-pregnancy overweight or obesity, poor blood sugar control in GDM women, and improper neonatal feeding were risk factors for neonatal hypoglycemia. The results of logistic regression analysis showed that abnormal glucose metabolism in newborn (odds ratio [OR]: 2.43, 95% confidence interval [CI]: 1.12-4.73) and neonatal hypoglycemia (OR: 3.04, 95% CI: 1.33-5.79) were a risk factor. We also conducted the logistic analysis to evaluate the correlation between HbA1c before delivery and abnormal glucose metabolism in newborns of pregnant women with GDM through adjusting some potential factors. The results were still significant in the abnormal glucose metabolism in newborn (OR: 2.84, 95% CI: 1.23-6.63) and neonatal hypoglycemia (OR: 3.64, 95% CI: 1.46-8.18). Overweight or obesity of GDM parturient before pregnancy, poor blood glucose control of GDM parturient and improper feeding of newborns are all risk factors for neonatal hypoglycemia. HbA1c before delivery has a certain predictive value for abnormal glucose metabolism in newborns.

Early neonatal hypoglycemia in term and late preterm small for gestational age newborns

BACKGROUND

Neonatal hypoglycemia is a common metabolic occurrence among small for gestational age (SGA) neonates. This study aims to determine the incidence of early neonatal hypoglycemia and confirms the potential risk factors among term and late preterm SGA neonates in a well-baby newborn nursery of a tertiary medical center in Southern Taiwan.

METHODS

We performed a retrospective medical record review of term and late preterm SGA (birth weight <10 percentile) neonates, born between January 1, 2012 and December 31, 2020, in the well-baby newborn nursery, of a tertiary medical center in Southern Taiwan. Blood glucose monitoring was routinely performed at 0.5, 1, 2, and 4 h of life. Antenatal and postnatal risk factors were recorded. Mean blood glucose level, age of occurrence, symptomatic hypoglycemia, and need for intravenous glucose treatment of early hypoglycemia in SGA neonates were documented.

RESULTS

690 SGA neonates in the nursery met the criteria and were retrospectively enrolled in the study, 358 of whom (51.80%) were male and 332 (48.10%) female. Of 690 enrolled SGA neonates, 134(19.42%) SGA neonates developed hypoglycemia during a well-baby nursery stay. Among these neonates, 97% of early hypoglycemic episodes occur during the first 2 h of life. The lowest blood glucose level was 46.78 ± 11.13 mg/dL, recorded in the first hour of life. Among the hypoglycemic 134 neonates, 26 (19.40%) neonates had to be transferred from the nursery to the neonatal ward and they required intravenous glucose treatment to achieve euglycemia. 14 (10.40%) neonates had symptomatic hypoglycemia. A multivariate logistic regression analysis revealed that cesarean delivery, small head circumference, small chest circumference, and low 1-min Apgar score were significant risk factors for early hypoglycemia in these neonates.

CONCLUSION

Periodic routine blood glucose level monitoring within the first 4 h of life in term and late preterm SGA neonates is required, especially those with cesarean delivery and low Apgar score.

Incidence and risk factors for early hypoglycemia in very preterm infants: The hyporisk study

PURPOSE

To determine incidence, timing and potential risk factors associated with hypoglycemia in the first day of life in very premature infants.

METHODS

Retrospective cohort study including all infants born before 32 weeks of gestation between 1 July 2017 and 31 December 2020 in the Erasmus MC Sophia Children's Hospital (Rotterdam, the Netherlands). Excluded were those who died within 24 h after birth or with no glucose data available. We collected maternal and neonatal characteristics from patient files, as well as all routine glucose values for the first 24 h. Hypoglycemia was defined as blood glucose value below 2.6 mmol/L. Risk factors were selected using univariable and multivariable logistic regression with stepwise backward elimination. Kaplan-Meier survival analysis was performed to examine time-to-event after birth.

RESULTS

Of 714 infants included (median gestational age 29.3 weeks, mean weight 1200 g), 137 (19%) had at least one episode of hypoglycemia, with a median time-to-event of 126 min [95%-CI 105-216]. Relevant independent risk factors for hypoglycemia included two maternal (insulin-dependent diabetes [OR 2.8; 95%-CI 1.3-6.1]; antenatal steroid administration [OR 1.7, 95%-CI 1.1-2.7]), and four neonatal factors (no IV-access in delivery room [OR 6.1, 95% CI-3.2-11.7], gestational age in weeks [OR 1.3, 95% CI-1.2-1.5], small-for-gestational-age [OR 2.6, 95%-CI 1.4-4.8], and no respiratory support (versus non-invasive support) [OR 2.3, 95%-CI 1.0-5.3]).

CONCLUSION

Six risk factors were identified for hypoglycemia in the first 24 h of life in very preterm infants, that can be used for development of prediction models, risk-based screening and updating guidelines.

The incidence of and risk factors for hyperglycemia and hypoglycemia in preterm infants receiving early-aggressive parenteral nutrition

Introduction

Optimizing nutritional support helps prevent extra uterine growth restriction and adverse long-term outcomes in preterm infants.

Objectives

This study aimed to analyze the incidence of and risk factors for hyperglycemia and hypoglycemia in preterm infants receiving early-aggressive parenteral nutrition (PN).

Methods

This prospective observational study included preterm infants receiving PN at the Neonatal Intensive Care Unit of Dr. Soetomo General Hospital between April 2018 and May 2019. Potential risk factors analyzed included asphyxia, sepsis, respiratory distress syndrome, multiple congenital anomalies, mortality, necrotizing enterocolitis, retinopathy of prematurity, the postoperative period, inotropic administration, glucose infusion rate (GIR) > 10-12 mg/kg/min, GIR 4-<5.5 mg/kg/min, and increase in GIR <1 mg/kg/min.

Results

Of the 105 preterm infants included, hyperglycemia and hypoglycemia were found in 14 (13.3%) and 26 (24.8%) infants, respectively, with most incidents occurring in the first week (hyperglycemia: 85.7%; hypoglycemia: 88.5%). Sepsis was an independent risk factor for hyperglycemia (odds ratio [OR]: 8.743, 95% confidence interval [CI]: 2.392-31.959; P = 0.001). Hypoglycemia independent risk factors included the postoperative period (OR: 4.425, 95% CI: 1.218-16.073; P = 0.024) and use of GIR 4-<5.5 mg/kg/min (OR: 2.950, 95% CI: 1.035-8.405; P = 0.043).

Conclusion

Hyperglycemia and hypoglycemia can occur in preterm infants receiving early-aggressive PN; most cases occur within the first week of life. Hypoglycemia correlated with low glucose intake, and hyperglycemia correlated with sepsis. Monitoring blood glucose levels in preterm infants receiving PN, especially in the first weeks of life, may decrease morbidity associated with hyperglycemia or hypoglycemia.

Development of a prediction model for neonatal hypoglycemia risk factors: a retrospective study

Background

It's challenging for healthcare workers to detect neonatal hypoglycemia due to its rapid progression and lack of aura symptoms. This may lead to brain function impairment for the newborn, placing a significant care burden on the family and creating an economic burden for society. Tools for early diagnosis of neonatal hypoglycemia are lacking. This study aimed to identify newborns at high risk of developing neonatal hypoglycemia early by developing a risk prediction model.

Methods

Using a retrospective design, pairs (470) of women and their newborns in a tertiary hospital from December 2021 to September 2022 were included in this study. Socio-demographic data and clinical data of mothers and newborns were collected. Univariate and multivariate logistic regression were used to screen optimized factors. A neonatal hypoglycemia risk nomogram was constructed using R software, and the calibration curve and receiver operator characteristic curve (ROC) was utilized to evaluate model performance.

Results

Factors integrated into the prediction risk nomogram were maternal age (odds ratio [OR] =1.10, 95% CI: 1.04, 1.17), fasting period (OR=1.07, 95% CI: 1.03, 1.12), ritodrine use (OR=2.00, 95% CI: 1.05, 3.88), gestational diabetes mellitus (OR=2.13, 95% CI: 1.30, 3.50), gestational week (OR=0.80, 95% CI: 0.66, 0.96), fetal distress (OR=1.76, 95% CI: 1.11, 2.79) and neonatal body mass index (OR=1.50, 95% CI: 1.24, 1.84). The area under the curve (AUC) was 0.79 (95% confidence interval [CI]: 0.75, 0.82), specificity was 0.82, and sensitivity was 0.62.

Conclusion

The prediction model of this study demonstrated good predictive performance. The development of the model identifies advancing maternal age, an extended fasting period before delivery, ritodrine use, gestational diabetes mellitus diagnosis, fetal distress diagnosis and an increase in neonatal body mass index increase the probability of developing neonatal hypoglycemia, while an extended gestational week reduces the probability of developing neonatal hypoglycemia.

Determinants of neonatal hypoglycemia among neonates admitted at Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia: A retrospective cross-sectional study

Objective

The study aimed to assess the magnitude and determinants of neonatal hypoglycemia among neonates admitted to the Neonatal Intensive Care Unit at Hiwot Fana Specialized University Hospital, Eastern Ethiopia.

Methods

An institutional-based cross-sectional study was conducted among 698 randomly selected neonates at Hiwot Fana Comprehensive Specialized Hospital from 1 January 2018 to 31 December 2020. By looking at the charts, data were gleaned from the medical records. Data were entered into Epi-Data version 3.1 and analysis was performed using SPSS version 22. Bivariable and multivariable logistic regression analyses were conducted to identify determinant factors of neonatal hypoglycemia. Association was described using an adjusted odds ratio along with a 95% CI. Finally, a p-value <0.05 in the adjusted analysis was considered to declare a statistically significant association.

Results

Out of 698 neonates, 148 (21.2%; 95% CI: 18.3, 24.5) neonates had hypoglycemia. Preterm birth (AOR = 3.06; 95% CI: 1.02, 9.17), hypothermia (AOR = 2.65; 95% CI: 1.22, 5.75), neonatal sepsis (AOR = 2.61; 95% CI: 1.03, 6.59), diabetic mother (AOR = 2.34; 95% CI: 1.03, 5.33), and delay in initiation of breastfeeding for more than 1 h (AOR = 3.89; 95% CI: 1.17, 12.89) were identified as determinant factors of neonatal hypoglycemia.

Conclusion

The magnitude of neonatal hypoglycemia was quite common among neonates. Neonatal hypoglycemia was found to be predicted by preterm birth, hypothermia, neonatal sepsis, maternal diabetes mellitus, and delay in starting nursing. We therefore strongly suggest health-care workers work in the postnatal unit to manage and control these and other determinant factors of hypoglycemia to prevent the occurrence of neonatal hypoglycemia.

Murthi S, Alsaffar H, Al Mandhari H. Predictors of the Need to Use Medications in the Management of Neonatal Hypoglycemia

Background and objective Neonatal hypoglycemia (NH) is one of the most common causes of admission to the neonatal intensive care unit (NICU). Persistent NH despite adequate feeding and intravenous dextrose may often require medications to maintain normal blood glucose levels (BGL). Several medications are used in the management of persistent NH, such as glucagon, diazoxide, and octreotide. In this study, we aimed to determine the factors that predict the need for medications to treat persistent NH. Methods This was a retrospective cohort study conducted at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. Infants admitted to the NICU between 2015 and 2019 with hypoglycemia (capillary blood glucose <2.6 mmol/l) were eligible to be included in the study. A prespecified dataset was collected from electronic patient records, including birth weight (BW), APGAR scores, gestational age, BGL, maternal risk factors such as diabetes mellitus (DM), hypertension, or antenatal use of medications, and the NICU management during admission. Data analysis was performed using SPSS Statistics for Windows, version 27.0 (IBM Corp., Armonk, NY). Results A total of 89 neonates were admitted due to NH during the study period. Of them, 10 (11.2%) patients had received medication (diazoxide). Use of medication for persistent NH was significantly associated with maternal gestational diabetes/diabetes mellitus (GDM/DM) status (p=0.041), higher BW (p=0.001), and large for gestational age [LGA (defined as BW >90th percentile)] (p=0.014), severe hypoglycemia (mean glucose level of 1-1.5 mmol/l) at two hours of life and at admission, and elevated maximum glucose infusion rate (GIR). GIR for the medication-requiring cohort was 12.95 mg/kg/min and that for the non-medication-requiring cohort was 6.77 mg/kg/min (p<0.001). Conclusion Based on our findings, the need for using certain medications to treat persistent NH, such as diazoxide in neonates admitted with NH, can be predicted by factors such as maternal GDM/DM status, BW >90th percentile, very low BGL at two hours of age and on admission, and elevated GIR. Elevated maximum GIR was a leading indicator for using medications in the treatment of NH.

Identifying additional risk factors for early asymptomatic neonatal hypoglycemia in term and late preterm babies

BACKGROUND

Neonatal hypoglycemia is a common metabolic disorder in newborns, which may present with non-specific symptoms or even be asymptomatic. Current guidelines recommend screening for hypoglycemia in at-risk babies (late preterm, small for gestational age, large for gestational age, and infants of diabetic mothers). Past studies have suggested other potential risk factors, such as maternal obesity, gestational hypertension, cesarean section, etc. In this study, we aim to identify additional prenatal and perinatal maternal/fetal characteristics associated with early asymptomatic hypoglycemia in term and late preterm babies.

METHODS

We performed a retrospective review on medical charts of all newborns, born between January, 2017 and December, 2020, in the well-baby newborn nursery of a tertiary medical center. We identified newborns who had received blood glucose concentration monitor after birth. Detailed prenatal and perinatal maternal/newborn information were collected for analysis.

RESULTS

In the study period, 841 newborns had received blood glucose screening after birth. After matching by sex and indication for postnatal blood glucose screen (SGA, LGA, and GDM), 148 newborns were included in the "hypoglycemia group" and 296 newborns were included in the "euglycemia group". In the univariate analysis, parity, insulin treatment for gestational diabetes mellitus (GDM), and cesarean section were associated with an increased risk for neonatal hypoglycemia. Factors associated with decreased risk included higher gestational age, longer duration of skin-to-skin contact, neonatal hyperthermia, higher maternal labor pain score, and epidural anesthesia administration. By multivariable analysis, insulin treatment for GDM was identified as an independent factor associated with increased risk for neonatal hypoglycemia.

CONCLUSION

Our study showed insulin treatment for GDM to be independently associated with neonatal hypoglycemia. Other risk factors noted in the univariate analysis, such as decreased skin-to-skin contact duration, hypothermia, Cesarean section, and preterm delivery, would require further investigation to confirm the findings.

Incidence and Risk Factors for Glucose Disturbances in Premature Infants

Background and Objectives: There are limited data regarding the incidence and risk factors for hypoglycemia, hyperglycemia, and unstable glycemia in preterm infants. The aim of the present study was to determine the incidence and risk factors associated with neonatal hypoglycemia, hyperglycemia, and unstable glycemia in preterm infants during the first seven days of life. Materials and Methods: This prospective study included preterm infants <37 weeks of gestation, admitted to the Neonatal Intensive Care Unit between January 2018 and December 2020. Based on blood glucose levels in the first week of life, infants were divided into the following four groups: normoglycemic, hypoglycemic, hyperglycemic, and unstable. Blood glucose levels were measured from capillary blood at the 1st, 3rd, 6th, and 12th hour of life during the first 24 h, and at least once a day from days 2 to 7, prefeed. Results: Of 445 enrolled infants, 20.7% (92/445) were categorized as hypoglycemic, 9.9% (44/445) as hyperglycemic, and 2.9% (13/445) as unstable, respectively. Hypoglycemia was most commonly observed among infants ≥34 weeks (27.9%), and hyperglycemia was most common among preterm infants <28 weeks (50%). Female gender increased the chances of developing hypoglycemia by three times. The decrease in gestational age by one week increased the chance of developing hyperglycemia by 1.9 times. Sepsis increased the chance of developing hyperglycemia seven times, respiratory distress syndrome five times, and mechanical ventilation three times, respectively. Conclusions: Glucose disturbances in the early neonatal period in preterm infants are common and mostly asymptomatic. Therefore, careful blood glucose level monitoring is required in those infants, especially in late preterm infants, in order to prevent possible neurological complications.

Change to Hearing Loss-Related Risks and Screening in Preterm Infants

Hearing loss is one of the most common congenital defects in infancy; it increases speech and language delays and adversely affects academic achievement and socialemotional development. The risk of hearing loss in premature infants is higher than that in normal newborns, and because of the fragility of the auditory nervous system, it is more vulnerable to different risk factors. The hearing screening guidelines in current use were proposed by the American Academy of Pediatrics and updated in 2007, but there are no uniform guidelines for hearing screening in preterm infants. This review focuses on the risk factors related to hearing loss in premature infants, hearing screening strategies, and reasons for failure. The aim is to provide a more comprehensive understanding of hearing development in preterm infants to achieve early detection and early intervention. At the same time, attention should be paid to delayed auditory maturation in preterm infants to avoid excessive intervention. KEY POINTS: · Hearing loss is very common in infancy, especially in premature infants.. · Genetic factors, infection, hyperbilirubinemia, drugs, and noise are the main causes.. · We should pay attention to the delayed hearing maturity of premature infants and avoid excessive intervention..

Father newborn skin-to-skin wheelchair transfer from delivery room to neonatal care unit: Possible change in practices

OBJECTIVE

To evaluate the transfer of newborns from the delivery room to the neonatal care unit with their fathers on wheelchairs in terms of the safety of the procedure and paternal anxiety.

METHODS

A prospective observational single-center before-and-after pilot study was conducted from February to May 2018 at the University Maternity Hospital of Nantes. Safe transfer was judged on the basis of episodes of hypothermia or hypoglycemia. Paternal anxiety was assessed with the State-Trait Anxiety Inventory (STAI) scale after newborn transfer.

RESULTS

Overall, 70 preterm newborns were enrolled, 44 were carried in wheelchairs in the father's arms (target group) and 26 were transferred in an incubator (control group). After adjusting for gestational age and birthweight, there were no statistically significantly differences between the target and the control group in the rates of hypothermia (43.9% vs 30.8%, p = 0,59) and hypoglycemia (9.52% vs 19.23%, p = 0,19). The STAI scale score was not significantly different between groups after incubator transfer or wheelchair transfer, at 35 ± 8.2 and 38 ± 10.2, respectively (p = 0.07).

CONCLUSION

Transferring a newborn to the neonatal care unit via wheelchair with the father is a safe alternative to incubator transfer.

Association of antenatal steroids with surfactant administration in moderate preterm infants born to women with diabetes mellitus and/or hypertension

BACKGROUND

Randomized trials of antenatal steroid administration (ANS) for extreme or moderate preterm pregnancies excluded women with diabetes mellitus (DM) and included few with preeclampsia.

METHODS

Cohort study (n = 1,813) including moderate preterm births [29^0/7-33^6/7wks' gestational age GA)] before (Epoch-1) and after (Epoch-2) expansion of ANS administration to women with hypertensive disorders (HTN) and/or DM. We compared surfactant administration in Group-1 (neither HTN nor DM), Group-2a (HTN not DM), Group-2b (DM not HTN) and Group-2c (DM and HTN).

RESULTS

Surfactant administration was less frequent after ANS in Group-1 [adjusted odds ratio (aOR) 0.54, 95% confidence interval (CI) 0.31, 0.93, P = 0.03], Group-2a (aOR 0.36, CI 0.22, 0.58, P < 0.001) and Group-2c (aOR 0.29, CI 0.12, 0.71, P = 0.007) but not Group-2b (P = 0.64).

CONCLUSIONS

ANS administration was independently associated with less surfactant administration in moderately preterm neonates whose mothers had neither HTN nor DM, and those with HTN, but not those with DM without HTN.

The glucose infusion rate of parenteral nutrition in the first week of life in preterm infants: an observational study

Background

Most preterm infants require a continuous glucose infusion in the early postnatal period due to the interruption of the transplacental glucose supply after birth to promote better neurodevelopmental outcomes.

Aims

To investigate the glucose infusion rate (GIR) on parenteral nutrition (PN) in the first week of life administered in preterm infants and its effect on neonatal morbidity and mortality.

Methods

This study included 97 infants aged < 37 gestational weeks and weighed < 2500 g at birth. Infants recruited in this study were classified into 3 groups based on the GIR usage in parenteral nutrition as follows: GIR usage of 5- < 7 g/kg/day (Group I), GIR usage of 7–13 g/kg/day (Group II), and GIR usage of > 13–15 g/kg/day (Group III). Univariate and multivariate logistic regression analyzes were carried out to investigate whether the GIR usage in the three groups was associated with selected neonatal morbidities and mortality. Neonatal morbidities analyzed included respiratory distress syndrome (RDS), necrotizing enterocolitis, sepsis, retinopathy of prematurity, pulmonary hypertension, hypoglycemia, and hyperglycemia.

Result

Of 97 preterm infants included, 51.5% infants had a gestational age of 34- < 37 weeks, and 54.6% infants had a birth weight of 1500- < 2500 g. The multivariate logistic regression analysis showed that the GIR usage of 5- < 7 g/kg/day was an independent variable that significantly increased the risk of hypoglycemia (Adjusted Odds Ratio [AOR] = 4.000, 95% Confidence Interval [CI] = 1.384–11.565, P = 0.010) and reduced the risk of sepsis (AOR = 0.096, 95% CI = 0.012–0.757, P = 0.026). The GIR usage in all three groups did not increase the risk of mortality. For neonatal morbidity analyzed in this study, RDS (AOR = 5.404, 95%CI = 1.421–20.548, P = 0.013) was an independent risk factor of mortality.

Conclusion

The GIR usage of < 7 g/kg/day in PN in the first week of life administered to preterm infants was an independent variable in increasing hypoglycemia, but in contrast, reducing the risk of sepsis.

Racial and Ethnic Disparities in Health Care and Health Outcomes for Pregnant Women With Diabetes

This article summarizes the current literature on racial and ethnic differences among women with diabetes in pregnancy. The PubMed, Scopus, CINAHL, and Embase databases were searched for original qualitative or quantitative studies published in English from January 1, 2009, to May 31, 2020. Consensus statements were excluded. Results of this synthesis indicate that racial and ethnic differences exist among pregnant women with diabetes, including social determinants of health, disparities in maternity care and perinatal care, and maternal and neonatal health outcomes. Health care providers should implement tailored interventions that specifically target racial and ethnic disparities in maternal and neonatal health to promote health equity in pregnant women with diabetes and their offspring, including later in life.

Management of asymptomatic hypoglycemia with 40% oral dextrose gel in near term at-risk infants to reduce intensive care need and promote breastfeeding

Background

Neonatal hypoglycemia is a common disorder especially in at-risk infants and it can be associated with poor long-term neurological outcomes. Several therapeutic interventions are suggested, from the implementation of breastfeeding to the glucose intravenous administration. Oral dextrose gel massaged into the infant’s inner cheek is a recent treatment option of asymptomatic hypoglycemia, after which oral feeding is encouraged. This approach seems to reduce the admission of infants to neonatal intensive care unit (NICU) so favouring maternal bonding and breastfeeding success at discharge.

Methods

In our ward, we prospectively compared a group of near-term neonates, (Gr2, n = 308) at risk for hypoglycemia, treated with an innovative protocol based on the addition of 40% oral dextrose gel (Destrogel, Orsana®,Italy) administered by massaging gums and cheek with historical matching newborns (Gr1, n = 389) treated with a formerly used protocol, as control group. The primary outcome was occurrence of NICU admission and the requirement of intravenous glucose administration; while discharge with full breastfeeding was the secondary outcome.

Results

In Gr1, 39/389 (10%) infants presented with asymptomatic hypoglycemia, 19/39 were transferred to the NICU, and 14/39 required intravenous glucose treatment. In Gr2, among the 30/308 infants with asymptomatic hypoglycemia managed according to the new protocol, 3/30 were transferred to the NICU and received intravenous glucose infusion. The mean duration of hospitalization respectively was 6.43 (± 6.36) and 3.73 ± 1.53 days (p <  0.001). At discharge, 7.7% of the infants in Gr1 and 30% of the infants in Gr2 were exclusively breastfed (p = 0.02). Considering Gr1 vs Gr2, the number of patients that were transferred to NICU was 19 (48.7%) vs 3 (10%) (p = 0.001) and the number of infants that needed intravenous glucose infusion was 14 (35.9%) vs 3 (10%) (p = 0.01), respectively.

Conclusions

In our population of near term infants, the introduction of 40% oral dextrose gel to the protocol, helped in the safe management of asymptomatic hypoglycemia and, at the same time, implemented breastfeeding.

The diagnosis of Gestational Diabetes Mellitus and its impact on In Vitro Fertilization pregnancies. A pilot study

BACKGROUND

In Vitro Fertilization (IVF) is increasingly becoming a necessary mode of reproduction. This high risk group is prone to Gestational Diabetes Mellitus (GDM) which further exposes these pregnancies to an increased risk of adverse outcomes. In light of the limited data in the current literature, further investigation is needed regarding the time of GDM diagnosis in IVF pregnancies as well as the outcome of IVF pregnancies complicated by GDM.

METHODS

In this three center pilot cross sectional study, the data of 101 singleton IVF pregnancies complicated by GDM were analyzed. Prompt GDM diagnosis in IVF pregnancies was accomplished by self-blood glucose monitoring (SMBG) from the first antenatal visit and confirmed by an OGTT. To evaluate pregnancy outcome, maternal and fetal complications in the 101 GDM IVF group was compared to 101 IVF as well as 101 spontaneous conceptions (SC). The three groups were matched by age. The effect of demographic and glycemic parameters on the outcome of GDM IVF pregnancies was investigated.

RESULTS

GDM diagnosis was made before the 24th week in 37.6% of the GDM IVF group. The week of delivery was earlier for the GDM IVF group (37 ± 1.7) relative to the IVF (37.9 ± 0.9, p < 0.001) and the SC group (38.1 ± 0.8, p < 0.001). GDM IVF pregnancies exhibited greater preeclampsia rates and 84.8% underwent caesarian section. No significant difference regarding LGA and SGA birth weights was found. Complications of GDM IVF pregnancies were associated with the 1-h postprandial BG (r = 0.267, p = 0.007).

CONCLUSION

GDM screening in IVF pregnancies may be considered earlier than the 24th week. IVF pregnancies affected by GDM are prone to increased maternal and fetal complications which are associated with 1-h postprandial BG.

[Prospective study on influence of perinatal factors on the development of early neonatal hypoglycemia in late-preterm and term infants]

INTRODUCTION AND OBJECTIVE

Neonatal hypoglycemia offers multiple controversies. The study aims to assess the main factors involved in the development of early hypoglycemia in term and late preterm infants, and the implication of different environmental circumstances.

METHODS

A prospective cohort study, in infants born between 34 0/7 weeks and 36 6/7 weeks of gestation. Three capillary blood glucose determinations were performed during the eight first hours after birth.

SAMPLE SIZE

207; 59 neonates developed hypoglycemia.

RESULTS

Prenatal risk factors include gestational diabetes with poor glycemic control, twin pregnancy and gestational age. The presence of meconium amniotic fluid and planned cesarean delivery are associated with a higher probability of hypoglycemia. After birth, skin to skin contact, breastfeeding, soft lightening, and normothermia are described as protective factors. The predictive model that combines the type of lightening, body temperature and the excess of bases level, correctly classifies 98% of the severe hypoglycemia cases, with a high Nagelkerke R2 value (0.645) and specificity of 99.5%.

CONCLUSIONS

Postnatal environmental factors seem to be directly related to early hypoglycemia development, so it is essential to support the maternal-child union and breastfeeding. Our results allow better identification of neonates who are not subsidiary to performing blood glucose determinations because they have little risk of developing it.

Neonatal Hypoglycemia and Brain Vulnerability

Neonatal hypoglycemia is a common condition. A transient reduction in blood glucose values is part of a transitional metabolic adaptation following birth, which resolves within the first 48 to 72 h of life. In addition, several factors may interfere with glucose homeostasis, especially in case of limited metabolic stores or increased energy expenditure. Although the effect of mild transient asymptomatic hypoglycemia on brain development remains unclear, a correlation between severe and prolonged hypoglycemia and cerebral damage has been proven. A selective vulnerability of some brain regions to hypoglycemia including the second and the third superficial layers of the cerebral cortex, the dentate gyrus, the subiculum, the CA1 regions in the hippocampus, and the caudate-putamen nuclei has been observed. Several mechanisms contribute to neuronal damage during hypoglycemia. Neuronal depolarization induced by hypoglycemia leads to an elevated release of glutamate and aspartate, thus promoting excitotoxicity, and to an increased release of zinc to the extracellular space, causing the extensive activation of poly ADP-ribose polymerase-1 which promotes neuronal death. In this review we discuss the cerebral glucose homeostasis, the mechanisms of brain injury following neonatal hypoglycemia and the possible treatment strategies to reduce its occurrence.

[Risk factors for hypoglycemia in preterm infants with a gestational age of ≤32 weeks]

OBJECTIVE

To investigate the risk factors for hypoglycemia after birth in preterm infants with a gestational age of ≤32 weeks.

METHODS

A retrospective analysis was performed for 86 neonates with hypoglycemia and a gestational age of ≤32 weeks who were admitted to the neonatal intensive care unit from January 2017 to June 2020 (hypoglycemia group). A total of 172 preterm infants with normal blood glucose who were hospitalized during the same period were randomly enrolled as the control group. Univariate analysis and multivariate logistic regression analysis were used to screen out the risk factors for hypoglycemia in preterm infants.

RESULTS

There were 515 preterm infants during the study, among whom 86 (16.7%) had hypoglycemia. Compared with the control group, the hypoglycemia group had significantly higher percentages of small for gestational age (SGA), cesarean section, maternal hypertension, and antenatal steroid administration (P<0.05), but significantly lower birth weight and rate of intravenous glucose use before blood glucose test (P<0.05). SGA (OR=4.311, 95%CI: 1.285-14.462, P<0.05), maternal hypertension (OR=2.469, 95%CI: 1.310-4.652, P<0.05), and antenatal steroid administration (OR=6.337, 95%CI: 1.430-28.095, P<0.05) were risk factors for hypoglycemia in preterm infants, while intravenous glucose use (OR=0.318, 95%CI: 0.171-0.591, P<0.05) was a protective factor against hypoglycemia in preterm infants.

CONCLUSIONS

SGA, maternal hypertension, and antenatal steroid administration may increase the risk of early hypoglycemia in preterm infants with a gestational age of ≤32 weeks, and intravenous glucose use is recommended as soon as possible after birth for preterm infants with a gestational age of ≤32 weeks to reduce the incidence rate of hypoglycemia.

[Risk factors for hypoglycemia in preterm infants with a gestational age of ≤32 weeks]

OBJECTIVE

To investigate the risk factors for hypoglycemia after birth in preterm infants with a gestational age of ≤32 weeks.

METHODS

A retrospective analysis was performed for 86 neonates with hypoglycemia and a gestational age of ≤32 weeks who were admitted to the neonatal intensive care unit from January 2017 to June 2020 (hypoglycemia group). A total of 172 preterm infants with normal blood glucose who were hospitalized during the same period were randomly enrolled as the control group. Univariate analysis and multivariate logistic regression analysis were used to screen out the risk factors for hypoglycemia in preterm infants.

RESULTS

There were 515 preterm infants during the study, among whom 86 (16.7%) had hypoglycemia. Compared with the control group, the hypoglycemia group had significantly higher percentages of small for gestational age (SGA), cesarean section, maternal hypertension, and antenatal steroid administration (P<0.05), but significantly lower birth weight and rate of intravenous glucose use before blood glucose test (P<0.05). SGA (OR=4.311, 95%CI: 1.285-14.462, P<0.05), maternal hypertension (OR=2.469, 95%CI: 1.310-4.652, P<0.05), and antenatal steroid administration (OR=6.337, 95%CI: 1.430-28.095, P<0.05) were risk factors for hypoglycemia in preterm infants, while intravenous glucose use (OR=0.318, 95%CI: 0.171-0.591, P<0.05) was a protective factor against hypoglycemia in preterm infants.

CONCLUSIONS

SGA, maternal hypertension, and antenatal steroid administration may increase the risk of early hypoglycemia in preterm infants with a gestational age of ≤32 weeks, and intravenous glucose use is recommended as soon as possible after birth for preterm infants with a gestational age of ≤32 weeks to reduce the incidence rate of hypoglycemia.